A Lump 2

Posted on April 20, 2005 in Anxiety Glands

Yesterday’s visit to the facial surgeon compounded my anxiety. I had had the idea that it would involve outpatient surgery — going in, getting the lump sucked or cut out, then going home the same day. They handed me six pages which described the procedure in detail. As I sat in the enormous oversized sitting chairs among women who had come for face lifts or nose jobs, I felt the muscles around my rib cage tighten and a twinge that shot across my sternum.

The complications list was cause for alarm:

1. Damage to the facial nerve with resultant weakness or paralysis of the facial muscles on that side of the facre. This is a rare but serious complication. In some situations, the tumor has already invaded one or more branches of the facial nerve. Ultimately, if this is a malignant tumor, one or more branches of the facial nerve may need to be sacrificed in order to give it the best chance for cure. Every effort will be made to save all nerve branches. Temporary facial weakness occurs more frequently, and will usually resolve in days or weeks.
2. Bleeding or hematoma. In vry rare situations, a need for blood products or a blood transfusion. You have the right, should you choose, to have autologous or designated donor directed blood prepared in advance in case an emergency transfusion is necessary. You are encouraged to consult with your doctor if you are interested in this option.
3. Frey’s syndrome or gustatory sweating, which is characterized by localized sweating of the skin overlying the parotid gland in response to salivary stimulation.
4. Need for further and more aggressive surgery.
5. Need for adjuvant therapy such as radiation therapy or chemotherapy. Some tumors are best treated by combined therapy such as surgery with postoperative radiation therapy.
6. Loss of skin flaps with a poor cosmetic result.
7. Asymmetry of the face from loss of tissue volume. In many situations a muscle flap can be swung into the defect to partially camouflage the defect following a parotidectomy.
8. Permanent numbness of the side of the face, upper neck, and the ear. Ear numbness is probably the most common complaint following parotidectomy.
9. Scar
10. First bite syndrome. A very rare complication following parotid surgery in which patients will have pain with the first bite of their meal.
11. Prolonged pain, impaired heling, and the need for hospitalization.
12. Recurrence of the tumor or failure to cure the tumor despite effective therapy.
13. Salivary fistula. This occurs after parotid surgery when saliva may drain through the wound. This is usually a self-limiting problem and will go away with extra wound care.

I am remembering that I have survived asthma, a heart condition, diabetes, bipolar disorder, and gout to get to this point. Nevertheless, this has sent me for a mood spin. I chop about in the waters of my head, going back and forth in opinions about people and events. (Except I have never stopped believing that Ratzinger was a poor choice for Pope.)

Most distressing and likely of these complications is the loss of feeling in my ear. I won’t lose hearing, just sensation. I’m told that this doesn’t sound like much until it happens to you. I’ve warned friends that they might catch me pulling and scratching at the lobe of my ear due to the unavoidable damage to the facial nerve. But, for safety, they’ve got to get it all out and check the pathology. Still, I’d take a nasty looking facial scar in exchange for the feeling in that ear.

The possibility of the lump being malignant does not faze me nearly as much. When I faced the possibility of open heart surgery last summer, I merely said to myself that I knew I could make it. I believe the same about cancer: if the lump proves malignant, it probably has not spread. Chemotherapy will be nauseating and otherwise painful, but I don’t freak about throwing up like some people do. I’ve always seen it as nature’s way of expelling poisons. My hair will grow back. I’ll have an excuse to buy some new hats.

That’s not likely, however. What will bother me is the damned ear. And maybe a temporary loss of facial movement. Imagine my face sagging on the left side.

It’ll be strange feeling the loss of body parts whose sensations and movement I have taken for granted. I keep pinching the ear lobe and smiling, just to know what that feels like in the lasting numbness to come.